胰腺无功能性内分泌肿瘤的螺旋CT诊断与鉴别诊断

目的:分析胰腺无功能性内分泌肿瘤螺旋CT多期扫描的表现,提高CT对无功能性胰腺内分泌肿瘤诊断的正确性。材料和方法:回顾性分析25例经穿刺及手术病理证实的胰腺无功能性内分泌肿瘤的薄层螺旋CT多期扫描资料。螺旋CT采用常规平扫和薄层三期动态增强扫描即动脉期、门脉期和延迟期,三期扫描延迟时间分别为25s,70s和120s。结果:25例患者共检出26个病灶,位于胰头部10个病灶,胰颈部5个病灶,胰体部3个病灶,体尾部4个病灶,胰尾部4个病灶,其中1例同时有两个病灶分别位于胰头和体尾部。肿瘤平均大小为4.0cm。14个病灶呈等密度;12个病灶呈略低密度,密度不均匀,其中可见更低密度灶;其中5个病灶内可见钙化。增强扫描动脉期共18个病灶明显强化,其中6个病灶均匀强化,12个病灶不均匀强化,6病灶呈中等程度强化,2个病灶动脉期轻度强化。3例肿瘤位于胰头者,2例出现了胆道和胰管扩张,胰体尾部萎缩,另1例仅出现胰管轻度扩张,1例肿瘤位于体部者出现远端胰管扩张伴实质萎缩。25例患者8例出现多发肝富血供转移灶,其中1例患者同时出现肺和脊柱的多发转移,无胰周及后腹膜淋巴结转移;3例出现肿瘤邻近血管的侵犯,其余为邻近血管推移受压改变。结论:无功能性胰腺内分泌肿瘤多较大,富血供,常见钙化,较少出现周围血管及胰胆管直接侵犯,较少出现后腹膜淋巴结转移及神经丛侵犯,根据有无肝脏及其他脏器转移、淋巴结转移及周围血管侵犯,进一步提示肿瘤的良恶性。

Spiral CT Diagnosis and Differential Diagnosis of Nonfunctioning Endocrine Tumors of the Pancreas

The aim of this study was to analyze the CT feaures of nonfunctioning endocrine tumors(NFETs) of the pancreas by enhanced multi-phase spiral CT, distinguishing this tumor from other pancreatic tumors. Materials and Methods:Twenty-five cases with 26 lesions histopathologically proven NFETs of the pancreas were studied with multi-phase spiral CT and retrospectively analyzed. The spiral CT findings were investigated by using pre-contrast and post-contrast scanning including arterial, portal venous and delay phase. The contrast-enhanced scan started 25s, 70s and 120s after the initiation of injection of the contrast media. Results:The average size of tumor was 4.0cm. 10 lesions were located in the pancreatic head, 6 in the neck, 3 in the body, 4 in the body-tail and 4 in the pancreatic tail. On pre-contrast images, 14 lesions showed isodensity and 12 lesions showed mild hypodensity. Calcifications were detected in 5 of 26 lesions(19.23%).Marked enhancement of the lesions accounted for 69.23%(18/26) on arterial phase. Among the above lesions ,6 tumors were homogenously enhanced and 12 were heterogenously enhanced. Moderate enhancement of the lesions accounted for 23.08%(6/26).There were only 4 cases with mild dilatation of common bile duct and /or pancreatic duct, 8 cases with hepatic metastases and 1 cases with lung and spinal metastases. Peripancreatic vessels were invaded in 3 cases.Conclusion:NFETs of the pancreas presented with moderate to marked enhancement during arterial phase.The tumors maybe large and calcifications usually be detected. Meanwhile, NFETs of the pancreas were less likely to invaded the common bile duct and pancreatic duct, and less likely to invaded peripancreatic vessels.